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Just what was the BMA opposing in 1948?

Filed Under (Aneurin Bevan, BMA, Health Policy) by Paul on 30-04-2012

A couple of weeks ago I reiterated the position that I often take about the BMA – the one that reminds us all that in February 1948 over 90% of the BMA said that they, as doctors, would not be a part of the NHS. Then, in July of the same year over 90% of GPs joined.

My main reason for bringing this up was not to say that the BMA was against the NHS but rather to point out to contemporary politicians how feeble what appears to be the BMA’s very powerful intransigence actually is – if you challenge them.

However the question about what the BMA were actually opposing in 1948 was raised by others. I was pleased when doctors took this up and posted two comments on two different issues. First, they asked, why do I keep on ‘going on’ about something that the BMA did 60 years ago?  And second they stated that BMA was not against the NHS but against a particular method of funding of doctors.

I am genuinely grateful for these challenges because they made me go back and read Michael Foot’s great biography of Aneurin Bevan – Volume 2 published by David Poynter in 1973.

Between 1974 and 1984 this book formed the backbone of the annual lectures I gave in my course on the history of the welfare state.

It has been a pleasure to go back to it because the subject of the book is a great and funny man – Aneurin Bevan – and the author is a brilliant writer with a great sense of humour – of which more later.

But why do I keep going back to ‘have a go’ at the BMA about something they did 60 years ago? Apart from the point I make above – about the BMAs powerful constancy of purpose – the reason I keep going on about the founding of the NHS is that the BMA themselves have been going on about it for the last few years.

As we saw during the passage of the government’s Health and Social Care Act, the BMA stressed how much they wanted to save the NHS. They stressed the longevity of this really important institution and therefore it seems to me quite right to explore what their position was at its birth. What is it about the NHS now that they are trying to save – and what was it in 1948 that they were really trying to stop?

This was not just a matter of a method of payment.

I commend readers to chapters 3 and 4 of the above book. It’s a thrilling account of how a major politician with a very large popular mandate developed a 2 year campaign to negotiate with, isolate, and finally and crushingly ignore the BMA and its attacks upon the NHS Act.

When in Government this was required reading for the politicians with whom I worked.

I just want to share three issues from this story in this post.

The first is to answer the question about what was the BMA against in 1948. Was it a technical issue about payment or was it a matter of greater principle?

Some quotes from the book.

In December 1947 the BMJs estimate of the conflict showed that this was not a small issue’

“The conflict between Mr Bevan and the profession centres around one fundamental principle, and no assurance or gloss from him can alter that fact.. The National Health Service Act commends itself to the political party in power because it leads unmistakably to the eventual establishment of a whole time state medical service” (p 171)

And to underline this point,

 “What the profession would be voting about in the forthcoming plebiscite was ‘their continued existence as a body of free men’”” (p 171)

In early 1948 the BMA Council’s message to every doctor stated that

‘the issue is not one of money or compensation but is the intellectual freedom and integrity of a great profession’ (p 173)

…and on January 17 1948 the BMJ said,

 “If doctors hold fast to the centuries old detestation of state medicine… 500 years ago medicine needed to free itself from the dictatorship of authority. The authority of Galen. The freedom was won by men who fought fearlessly. Today we are faced with that recurring historical phenomenon the dictatorship of the State” (p 174)

In his Feb 9th speech to the House Bevan outlined what had happened in a 2 day negotiating meeting with the BMA the previous December,

“I was presented with a printed circular which they themselves had caused to be printed rejecting the Act before the final negotiations had taken place. All the main features of the Act are rejected in this document not just remuneration, not merely basic salary, not merely appeals to the courts, but every important provision of the Act has been rejected by the Negotiating Committee before negotiations were completed.” (pp179-180).

So the BMA rejected the whole Bill – not just the remuneration.

In their own words they were “struggling for the soul of the nation and for 500 years of medical freedom”. This does seem to me to go a bit beyond a matter of methods of remuneration.

They were against it all. Bevan was in favour of it all.

The second point from this period of history that matters for us today is that Bevan correctly understood the BMA’s relationship with government. Their problem was not just with him as a Minister, but with all governments over all time.

Again in his Feb 9th speech he said,

“I am very conscious of my limitations. But it can hardly be suggested that the conflict between the BMA and the Minister of the day is a consequence of any deficiencies that I possess, because we have never been able to appoint a Minister of Health with which the BMA agrees.” (p178)

Bevan then goes through the Ministers of Health that had been appointed from all political parties and characterises what the BMA thought about them:

The Liberal Minister of Health the BMA found anathema

The Liberal National Minister of Health the BMA found abominable

The Conservative Minister of Health the BMA found intolerable

Bevan was comforted by the fact that the BMA hated every Government Minister.

This is both great politics and very true.

Over the last 30 years Secretaries of State have come and go. A look at the list suggests that most people would think they were very different.

Thatcherite,  Majorite, New Labour, Old Labour, Real Labour and now Cameroonian Conservative.

All with very different politics, but the one thing that unites them all is the fact that the BMA fundamentally disagrees with them all.

The third lesson from this period is how Bevan viewed what appeared to be very powerful professional opposition. In the summing up of the debate his attack upon the BMA is coruscating,

“I should have thought and we all hoped that the possibilities contained in the Act would have excited the medical profession, that they would have recognised that we were setting their feet on a new path entirely, that they ought to take pride in the fact that, despite our financial and economic anxieties, we are still able to do the most civilised thing in the world – put the welfare of the sick in front of every other consideration. I therefore deplore the fact that the best elements of the profession have been thrust to one side by medical politicians who are not really concerned with the welfare of the people or the people of their own profession, but are seeking to fish in these troubled waters. I hope the House will not hesitate to tell the BMA that we look forward to this Act starting on July 5, and we expect the medical profession to take their proper part in it because we are satisfied that there is nothing in it that any doctor should be otherwise than proud to acknowledge.” (p 191)

That was on February 9th 1948.

Later that month 90% of the BMA voted against the Act. Bevan said,

“The Act will come into operation on July 5 in accordance with Parliament’s decision”

Five months later, on July 5th, the NHS began. 90% of GPs were a part of the scheme from the very beginning.

The rest, as they say, is history.


3 Responses to “Just what was the BMA opposing in 1948?”

  1. Paul you should know better from your time in government that any union in negotiations will often reject an entire government package if one of their demands is not met, regardless of whether they agree or not with the other parts of the package.
    All I can deduce from your repeated attacks on the BMA is that you are truly committed to the undoing of Bevan’s masterwork and are in fact one of his biggest and dirtiest traitors.

  2. Though no expert in the machinations of BMA intrigues my view is that the BMA is just an organism jealously protecting its not inconsiderable privileges and promoting its own interests. Everything else is secondary. This is, of course, so obvious as to not need stating. But state it I do!

  3. to repeat your quote, ‘the best elements of the profession have been thrust to one side by medical politicians who are not really concerned with the welfare of the people or the people of their own profession, but are seeking to fish in these troubled waters.’ The medical profession are as varied as any other group of workers. Time was when academic sucess and influence assured places at medical school. Acceptable personality traits have crept in as desireable but then we also know what is said about power, it corrupts. Not everyone of course, but society still puts clay feet on pedestals. Doctors are treated as people with authority, they can hold lives in their hands, is it any wonder they expect to determine their own destinies?

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